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Pharmacists can help facilitate this
process and aid in reducing ‘diabetes
distress’ through discussions about
the use of insulin injections and
self-monitoring of blood glucose.
Pharmacists can help by referring
patients to other members of the
healthcare team whenever they identify
that the patient is no longer reaching his
or her blood glucose target with current
therapy. Referral to a credentialed
diabetes educator can further assist by
providing the patient with education
on correct injection technique, support
with any issues she or he may be
experiencing and provide them with
the latest technology available to
Dose, form and pharmacokinetics are
important factors to consider with
any drug therapy. With injectable
therapies there is another important
factor, which is injection technique.
Injection technique is a critical
component of diabetes education.
Accurate administration of these
therapies improves the quality of life
of people living with diabetes.
There have been multiple advances
around correct injection technique
such as choosing which site to inject,
rotating injection sites, improvement in
needle technology and use of devices
that reduce the number of injections
required. An example of such a device
is the iPort AdvanceTM created by
Barriers in commencing
A recent review of hospital clinic records
found that the average duration of
diabetes before initiation of insulin was
11 years and of those patients, 40% had
already developed microvascular
Many studies have shown it is not
only the patient’s beliefs but also
the physician’s beliefs that can
influence the transition from oral to
CONTINUING PROFESSIONAL DEVELOPMENT
If the clinician initiates the discussion
around insulin therapy early and
addresses the patient’s concerns, the
patient may be more likely to consider
insulin as a treatment and less likely
to blame themselves for needing it.
Also the healthcare environment and its
policies influence patient beliefs around
insulin therapy for diabetes.6 If the
clinician’s attitude is to delay insulin
therapy for as long as possible, it also
reflects on the patient’s beliefs around
insulin and contributes to diabetes
distress and self-blame.
If people living with diabetes were
gradually able to prepare for the start
of insulin therapy, they would be less
likely to experience distress about it.2
Thus ongoing education from their
healthcare team around the progressive
nature of type 2 diabetes and the
likelihood of requiring insulin at some
point, may help ease the transition.
Patients who experienced increased
diabetes distress were likely to have
higher levels of self-blame with regards
to commencing insulin therapy.2
Those who had positive relationships
with their healthcare providers or were
actively involved in their diabetes
management, had lower levels of distress
and self blame.
Anxiety around needles can also prevent
early initiation of injectable therapies
There was a major advance
in injection technology with the
move from syringes to pen devices.
Multiple studies have shown that it is
the ease of administration of injectable
therapies which helps reduce fear and
anxiety in patients.
The risk of hypoglycaemia with insulin
therapy can also pose a barrier to
commencing therapy. The risk of
hypoglycaemia is lower with the newer
insulin analogues than with human
This risk of hypoglycaemia can
be minimised with self-blood glucose
monitoring, diabetes education and
ongoing reviews from the patient’s
clinician and allied healthcare team.
Weight gain is often a major concern
of both clinicians and patients with
type 2 diabetes.
However this can
be minimised if combined with lifestyle
modification and ongoing review of
12 Weight gain with insulin
may also be related to hypoglycaemia
as the patient may eat more to address
the hypoglycaemic episode. It is more
important that the insulin dose is
adjusted to avoid future hypoglycaemic
episodes than increase food intake.
Pharmacists have an important role in
reassuring patients about the benefits
of commencing insulin earlier and
addressing any patient concerns. If they
identify any issues they should promptly
refer the patient for review.
Increasing patient awareness of the
benefits of commencing an injectable
therapy, addressing any concerns
Figure 1. iPort device. (From: www.medtronicdiabetes.com/products/i-port-advance)
Standard vs. iPort
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